Patient dose monitoring and the use of diagnostic reference levels for the optimization of protection in medical imaging: current status and challenges worldwide
Open accessAbstract
Optimization is one of the key concepts of radiation protection in medical imaging. In practice, it involves compromising between the image quality and dose to the patient; the dose should not be higher than necessary to achieve an image quality (or diagnostic information) needed for the clinical task. Monitoring patient dose is a key requirement toward optimization. The concept of diagnostic reference level (DRL) was introduced by the International Commission on Radiological Protection as a practical tool for optimization. Unfortunately, this concept has not been applied consistently worldwide. To review the current strengths and weaknesses worldwide and to promote improvements, the International Atomic Energy Agency organized a Technical Meeting on patient dose monitoring and the use of DRLs on May 2016. This paper reports a summary of the findings and conclusions from the meeting. The strengths and weaknesses were generally different in less-developed countries compared with developed countries. Possible improvements were suggested in six areas: human resources and responsibilities, training, safety and quality culture, regulations, funding, and tools and methods. An overall conclusion was that radiation protection requires a patient-centric approach and a transfer from purely reactive to increasingly proactive optimization, whereby the best outcome is expected from good teamwork.
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International DRL programs enhance uniformity, safety, and quality assurance by establishing established benchmarks for radiation dosage levels.
“International DRL programs enhance uniformity, safety, and quality assurance by establishing established benchmarks for radiation dosage levels.96”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [96]
DRLs provide a universal foundation for dosage optimization, but their application differs markedly among nations owing to variations in clinical practices, healthcare infrastructure, and regulatory contexts.
“While DRLs provide a universal foundation for dosage optimization, their application differs markedly among nations owing to variations in clinical practices, healthcare infrastructure, and regulatory contexts.96”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [96]
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- Authors
- Järvinen, H., Vassileva, J., Samei, E., Wallace, A., Vano, E., & Rehani, M.
- Affiliations
- Radiation and Nuclear Safety Authority (FI)
- International Atomic Energy Agency (AT)
- Duke University (US)
- Australian Radiation Protection and Nuclear Safety Agency (AU)
- Universidad Complutense de Madrid (ES)
- Harvard University (US)
- Venue
- Journal of Medical Imaging
- Publisher
- SPIE-Intl Soc Optical Eng
- Published
- 2017-10-04
- Volume
- 4
- Issue
- 03
- Pages
- 1-7
- ISSN
- 2329-4302 (ISSN-L)
- 2329-4310
- PMC
- PMC5627781
- OpenAlex
- W2764147527
- Cited by
- 45
- References
- 14
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 5 · 2023: 7 · 2022: 3 · 2021: 6 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 1
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of medical imaging (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- International Atomic Energy Agency
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- patient dose monitoring, diagnostic reference levels, radiation protection optimization, diagnostic imaging, ICRP, International Atomic Energy Agency, quality culture, radiation protection regulation, developing countries
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